Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Torlén, Klara; Kalantar-Zadeh, Kamyar; Molnar, Miklos Z.; Vashistha, Tania; Mehrotra, Rajnish

doi:10.2215/cjn.00960112

Cited by 126 publications

(156 citation statements)

References 25 publications

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“…Low arterial pH is associated with hyperkalemia from a transcellular shift of potassium, a significant predictor of death risk (29,30). In our cohort, the likelihood of significant hyperkalemia increased with decrease in serum bicarbonate.…”

Section: Discussionmentioning

confidence: 55%

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Vashistha

Kalantar-Zadeh

Molnar

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Uremic metabolic acidosis is only partially corrected in many hemodialysis patients, and low serum bicarbonate predicts higher death risk. This study determined the comparative efficacy of peritoneal dialysis in correcting uremic metabolic acidosis and the association of serum bicarbonate and death risk with the two therapies. Design, setting, participants, & measurements Data were obtained from 121,351 prevalent ESRD patients (peritoneal dialysis, 10,400; hemodialysis, 110,951) treated in DaVita facilities between July 1, 2001 and June 30, 2006, with follow-up through June of 2007. Results Serum bicarbonate was <22 mEq/L in 25% and 40% of peritoneal dialysis and hemodialysis patients, respectively. Thus, peritoneal dialysis patients were substantially less likely to have lower serum bicarbonate (adjusted odds ratio<20 mEq/L, 0.45 [0.42, 0.49]; <22 mEq/L, 0.41 [0.39, 0.43]). Time-averaged serum bicarbonate<19 mEq/L was associated with an 18% and 25% higher risk for all-cause and cardiovascular mortality, respectively, in prevalent peritoneal dialysis patients (reference group: serum bicarbonate between 24 and <25 mEq/L). In analyses using the entire cohort of peritoneal dialysis and hemodialysis patients, the adjusted risk for all-cause mortality was higher in most subgroups with serum bicarbonate<22 mEq/L, irrespective of dialysis modality. Conclusions The measured bicarbonate is significantly higher in peritoneal dialysis patients, suggesting that the therapy provides a more complete correction of metabolic acidosis than intermittent hemodialysis. Survival data suggest maintaining serum bicarbonate>22 mEq/L for all ESRD patients, irrespective of dialysis modality.

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Section: Discussionmentioning

confidence: 55%

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Vashistha

Kalantar-Zadeh

Molnar

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Additionally, this threshold for inclusion and assignment of dialysis modality has been used in previously published studies comparing outcomes in patients undergoing PD and HD. 7,11,44,45 All laboratory values, including serum calcium and serum phosphorus, were measured using standardized and automated methods in the central DaVita, Inc. laboratory (Deland, FL) within 24 hours of collection. Serum albumin was measured using the bromcresol green method.…”

Section: Data Sourcesmentioning

confidence: 99%

Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis

Rivara

Ravel

Kalantar-Zadeh

et al. 2015

Journal of the American Society of Nephrology

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Uncorrected serum calcium concentration is the first mineral metabolism metric planned for use as a quality measure in the United States ESRD population. Few studies in patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) have assessed the association of uncorrected serum calcium concentration with clinical outcomes. We obtained data from 129,076 patients on dialysis (PD, 10,066; HD, 119,010) treated in DaVita, Inc. facilities between July 1, 2001, and June 30, 2006. After adjustment for potential confounders, uncorrected serum calcium ,8.5 and $10.2 mg/dl were associated with excess mortality in patients on PD or HD (comparison group uncorrected calcium 9.0 to ,9.5 mg/dl). Additional adjustment for serum albumin concentration substantially attenuated the all-cause mortality hazard ratios (HRs) associated with uncorrected calcium ,8.5 mg/dl (HR, 1.29; 95% confidence interval [95% CI], 1.16 to 1.44 for PD; HR, 1.17; 95% CI, 1.13 to 1.20 for HD) and amplified the HRs associated with calcium $10.2 mg/dl (HR, 1.65; 95% CI, 1.42 to 1.91 for PD; HR, 1.59; 95% CI, 1.53 to 1.65 for HD). Albumin-corrected calcium $10.2 mg/dl and serum phosphorus $6.4 mg/dl were also associated with increased risk for death, irrespective of dialysis modality. In summary, in a large nationally representative cohort of patients on dialysis, abnormalities in markers of mineral metabolism, particularly high concentrations of serum calcium and phosphorus, were associated with increased mortality risk. Additional studies are needed to investigate whether control of hypercalcemia and hyperphosphatemia in patients undergoing dialysis results in improved clinical outcomes.

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“…As importantly, glucose absorption from dextrose-based dialysate or icodextrin metabolites can result in lower serum sodium levels [2,5,6]. That the effects of PD on serum electrolytes are different is exemplified by a significantly higher prevalence of hypokalemia and lower prevalence of metabolic acidosis compared with patients treated with maintenance hemodialysis [7,8].…”

Section: Introductionmentioning

confidence: 99%

Serum sodium and mortality in a national peritoneal dialysis cohort

Ravel

Streja

Mehrotra

et al. 2016

Nephrol. Dial. Transplant.

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A B S T R A C TBackground: Sodium disarrays are common in peritoneal dialysis (PD) patients, and may be associated with adverse outcomes in this population. However, few studies of limited sample size have examined the association of serum sodium with mortality in PD patients, with inconsistent results. We hypothesized that both hypo-and hypernatremia are associated with higher death risk in a nationally representative cohort of US PD patients. Methods: We sought to examine the association of serum sodium over time and mortality among 4687 adult incident PD patients from a large US dialysis organization who underwent one or more serum sodium measurements within the first 3 months of dialysis over January 2007 to December 2011. We examined the association of time-dependent and baseline sodium with allcause mortality as a proxy of short-and long-term sodium-mortality associations, respectively. Hazard ratios were estimated using Cox models with three adjustment levels: minimally adjusted, case-mix adjusted, and case-mix þ laboratory adjusted. Results: In time-dependent analyses, sodium levels <140 mEq/ L were associated with incrementally higher death risk in casemix models (ref: 140 to <142 mEq/L); following laboratory covariate adjustment, associations between lower sodium and higher mortality remained significant for levels <136 mEq/L. In analyses using baseline values, sodium levels <140 mEq/L were associated with higher mortality risk across all models (ref: 140 to <142 mEq/L). Conclusions: In PD patients, lower time-dependent and baseline sodium levels were independently associated with higher death risk. Further studies are needed to determine whether correction of dysnatremia improves longevity in this population.

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Serum Potassium and Cause-Specific Mortality in a Large Peritoneal Dialysis Cohort

Cited by 126 publications

References 25 publications

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Dialysis Modality and Correction of Uremic Metabolic Acidosis

Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis

Serum sodium and mortality in a national peritoneal dialysis cohort

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